Journal articles on the topic 'EMS'
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Wijesekera, Olindi, Amanda Reed, Parker S. Chastain, Shauna Biggs, Elizabeth G. Clark, Tamorish Kole, Anoop T. Chakrapani, et al. "Epidemiology of Emergency Medical Services (EMS) Utilization in Four Indian Emergency Departments." Prehospital and Disaster Medicine 31, no. 6 (September 19, 2016): 675–79. http://dx.doi.org/10.1017/s1049023x16000959.
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AbstractIntroductionWithout a universal Emergency Medical Services (EMS) system in India, data on the epidemiology of patients who utilize EMS are limited. This retrospective chart review aimed to quantify and describe the burden of disease and patient demographics of patients who arrived by EMS to four Indian emergency departments (EDs) in order to inform a national EMS curriculum.MethodsA retrospective chart review was performed on patients transported by EMS over a three-month period in 2014 to four private EDs in India. A total of 17,541 patient records were sampled from the four sites over the study period. Of these records, 1,723 arrived by EMS and so were included for further review.ResultsA range of 1.4%-19.4% of ED patients utilized EMS to get to the ED. The majority of EMS patients were male (59%-64%) and adult or geriatric (93%-99%). The most common chief complaints and ED diagnoses were neurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease.ConclusionsNeurological, pulmonary, cardiovascular, gastrointestinal, trauma, and infectious disease are the most common problems found in patients transported by EMS in India. Adult and geriatric male patients are the most common EMS utilizers. Emergency Medical Services curricula should emphasize these knowledge areas and skills.WijesekeraO, ReedA, ChastainPS, BiggsS, ClarkEG, KoleT, ChakrapaniAT, AshishN, RajhansP, BreaudAH, JacquetGA. Epidemiology of Emergency Medical Services (EMS) utilization in four Indian emergency departments. Prehosp Disaster Med. 2016;31(6):675–679.
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Szymanski, Michael R., Samantha E. Scarneo-Miller, M. Seth Smith, Michelle L. Bruner, and Douglas J. Casa. "Emergency Medical Service Directors’ Protocols for Exertional Heat Stroke." Medicina 56, no. 10 (September 24, 2020): 494. http://dx.doi.org/10.3390/medicina56100494.
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Background and Objectives: Emergency Medical Service (EMS) protocols vary widely and may not implement best practices for exertional heat stroke (EHS). EHS is 100% survivable if best practices are implemented within 30 min. The purpose of this study is to compare EMS protocols to best practices for recognizing and treating EHS. Materials and Methods: Individuals (n = 1350) serving as EMS Medical or Physician Director were invited to complete a survey. The questions related to the EHS protocols for their EMS service. 145 individuals completed the survey (response rate = 10.74%). Chi-Squared Tests of Associations (χ2) with 95% confidence intervals (CI) were calculated. Prevalence ratios (PR) with 95% CI were calculated to determine the prevalence of implementing best practices based on location, working with an athletic trainer, number of EHS cases, and years of directing. All PRs whose 95% CIs excluded 1.00 were considered statistically significant; Chi-Squared values with p values < 0.05 were considered statistically significant. Results: A majority of the respondents reported not using rectal thermometry for the diagnosis of EHS (n = 102, 77.93%) and not using cold water immersion for the treatment of EHS (n = 102, 70.34%). If working with an athletic trainer, EMS is more likely to implement best-practice treatment (i.e., cold-water immersion and cool-first transport-second) (69.6% vs. 36.9%, χ2 = 8.480, p < 0.004, PR = 3.15, 95% CI = 1.38, 7.18). Conclusions: These findings demonstrate a lack of implementation of best-practice standards for EHS by EMS. Working with an athletic trainer appears to increase the likelihood of following best practices. Efforts should be made to improve EMS providers’ implementation of best-practice standards for the diagnosis and management of EHS to optimize patient outcomes.
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Hirschhorn, Rebecca, Oluwagbemiga DadeMatthews, and JoEllen Sefton. "Exertional Heat Stroke Knowledge and Management among Emergency Medical Service Providers." International Journal of Environmental Research and Public Health 18, no. 9 (May 10, 2021): 5016. http://dx.doi.org/10.3390/ijerph18095016.
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This study evaluated emergency medical services (EMS) providers’ knowledge of exertional heat stroke (EHS) and assessed current EMS capabilities for recognizing and managing EHS. EMS providers currently practicing in the United States were recruited to complete a 25-item questionnaire. There were 216 questionnaire responses (183 complete) representing 28 states. On average, respondents were 42.0 ± 13.0 years old, male (n = 163, 75.5%), and white (n = 176, 81.5%). Most respondents were Paramedics (n = 110, 50.9%) and had ≥16 years of experience (n = 109/214, 50.9%) working in EMS. Fifty-five percent (n = 99/180) of respondents had previously treated a patient with EHS. The average number of correct answers on the knowledge assessment was 2.6 ± 1.2 out of 7 (~37% correct). Temporal (n = 79), tympanic (n = 76), and oral (n = 68) thermometers were the most prevalent methods of temperature assessment available. Chemical cold packs (n = 164) and air conditioning (n = 134) were the most prevalent cooling methods available. Respondents demonstrated poor knowledge regarding EHS despite years of experience, and over half stating they had previously treated EHS in the field. Few EMS providers reported having access to an appropriate method of assessing or cooling a patient with EHS. Updated, evidence-based training needs to be provided and stakeholders should ensure their EMS providers have access to appropriate equipment.
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Bourdon, E., A. B. Tanguay, F. K. Tounkara, A. Marois, and R. Fleet. "MP013: A portrait of rural pre-hospital services in the province of Québec." CJEM 18, S1 (May 2016): S70. http://dx.doi.org/10.1017/cem.2016.154.
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Introduction: Rural emergency departments (EDs) are important safety nets for 20% of Canadian citizens. In Quebec, the province’s 26 rural EDs treat an average of 19,000 patients/year and are on average 300 km from levels 1 and 2 trauma centers. These distances signify that Emergency Medical Services (EMS) play a considerable role in the care of rural patients. EMS in Quebec province are private local services. There are no published reports on EMS in rural Quebec. As part of a larger study on rural emergency care, this descriptive study aimed at offering a comprehensive portrait of EMS. Methods: We conducted semi-structured interviews with managers of all paramedic services in rural Quebec. Interview questions focused on number of transports, training, availability of telemetry, GPS technologies, and work schedules. Results: Fifty managers of the 51 private companies serving the 26 rural EDs in Quebec were interviewed (response rate 98%). All were primary care paramedics (PCP). In 2010, EMS transported 40,671 patients, with 10,228 emergency transports to the rural EDs. A total of 7956 inter-facility transfers were conducted, 1499 of them emergency. Each ED required between 88 and 700 inter-facility transfers. A total of 60% (n=31/51) had GPS technology, only 25% (n=13/51) had telemetry features. Work schedules varied with 13% (n=7/51) of companies offering shifts of less than 12 hours, 28% (n=14/51) 24/7 weekly shifts, and 56% (n=29/51) a combination. Conclusion: This is the first study to describe rural EMS in Quebec. The finding that Quebec’s rural EDs are served by 51 privately-owned companies is unique in Canada. The considerable number of EMS transports, including inter-facility transfers, may reflect lack of local resources in rural EDs, the vulnerable population served, or the increased trauma risk in rural areas. Future studies should examine inter-facility transport reasons, costs, times and adequate training/scope of EMS practice.
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Kim, Kwang-Ho, and Gyu-Sik Kim. "Implementation and Verification Analysis of Micro-EMS for Controlling EES." Journal of the Institute of Electronics and Information Engineers 52, no. 1 (January 25, 2015): 155–61. http://dx.doi.org/10.5573/ieie.2015.52.1.155.
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Tozija, Fimka, and Nikola Jankulovski. "Strategy to Improve Quality in Emergency Medical Services: from Assessment to Policy." Archives of Industrial Hygiene and Toxicology 64, no. 4 (December 1, 2013): 567–79. http://dx.doi.org/10.2478/10004-1254-64-2013-2337.
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AbstractThe aim of this paper was to present the strategic approach applied for improvement of quality in emergency medical services (EMS) in the Republic of Macedonia. This approach was accomplished through three stages: (I) assessment and recommendations for policies; (II) development of innovative evidence-based programmes; and (III) policy implementation. Strategic assessment of EMS was performed by applying WHO standard methodology. A survey was conducted in 2006/2007 on the national level in fifteen general hospitals, four university hospitals, and sixteen pre-hospital EMS. The overall evaluation was based on a hospital emergency department (ED) questionnaire, information on the general characteristics of the pre-hospital dispatch centre, review of ED medical records, and the patient questionnaire. The key findings of the assessment showed that EMS required extensive changes and improvements. Pre-hospital EMS was not well-developed and utilised. Hospital EDs were not organised as separate divisions ran by a head medical doctor. The diagnostic and treatment capacities were insufficient or outdated. Most of the surveyed hospitals were capable of providing essential diagnostic tests in 24 h or less. There was no follow-up of the EMS patients or an appropriate link between the hospital EDs and primary health care facilities. The main findings of the assessment, recommendations, and proposals for action served as the basis for new policies and integrated into Macedonia’s official strategy for emergency medical services 2009-2017.
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Leeies, Murdoch, Cheryl ffrench, Trevor Strome, Erin Weldon, Michael Bullard, and Rob Grierson. "Prehospital Application of the Canadian Triage and Acuity Scale by Emergency Medical Services." CJEM 19, no. 1 (August 10, 2016): 26–31. http://dx.doi.org/10.1017/cem.2016.345.
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AbstractObjectivesTriage is fundamental to emergency patient assessment. Effective triage systems accurately prioritize patients and help predict resource utilization. CTAS is a validated five-level triage score utilized in Emergency Departments (EDs) across Canada and internationally. Historically CTAS has been applied by triage nurses in EDs. Observational evidence suggests that the CTAS might be implemented reliably by paramedics in the prehospital setting. This is the first system-wide assessment of CTAS interrater reliability between paramedics and triage nurses during clinical practice.MethodsVariables were extracted from hospital and EMS databases. EMS providers determined CTAS on-scene, CTAS pre-transport, and CTAS on-arrival at hospital for each patient (N=14,378). The hospital arrival EMS CTAS (CTASarrival) score was compared to the initial nursing CTAS score (CTASinitial) and the final nursing CTAS score (CTASfinal) incuding nursing overrides. Interrater reliability between ED CTASinitial and EMS CTASarrival scores was assessed. Interrater reliability between ED CTASfinal and EMS CTASarrival scores, as well as proportion of patient encounters with perfect or near-perfect agreement, were evaluated.ResultsOur primary outcome, interrater reliability [kappa=0.437 (p<0.001, 95% CI 0.421-0.452)], indicated moderate agreement. EMS CTASarrival and ED CTASinitial scores had an exact or within one point match 84.3% of the time. The secondary interrater reliability outcome between hospital arrival EMS CTAS (CTASarrival) score and the final ED triage CTAS score (CTASfinal) showed moderate agreement with kappa =0.452 (p<0.001, 95% CI 0.437-0.466).ConclusionsInterrater reliability of CTAS scoring between triage nurses and paramedics was moderate in this system-wide implementation study.
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NYAHUNA, Thomas, and Mishelle DOORASAMY. "Environmental Management System and Financial Performance of Environmentally Sensitive Industries in South Africa." International Journal of Environmental, Sustainability, and Social Science 4, no. 2 (March 31, 2023): 400–407. http://dx.doi.org/10.38142/ijesss.v4i2.377.
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The influence of environmental management system (EMS) on corporate financial performance within the African corporate context has persistently remained lacking and inconclusive, attributed primarily to the absence of data. However, this study investigates the influence of EMS on corporate financial performance measured by earnings per share (EPS) of 65 Johannesburg Stock Exchange listed environmental sensitive companies from 2014 to 2018. Size was used as a control variable. Using SPPS version 28, this study discover vast evidence of a favourable association between EMS and EPS. The importance of EMA cannot be underestimated. Therefore, this study makes available valuable insights on in what way companies can wholly apply EMS to upsurge corporate financial performance. It was concluded that the government should regulate the implementation of EMS within companies as a source of climate change mitigation and as a strategy to upswing financial and environmental performance.
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Chen, Yenming J., Yenchun Jim Wu, and Tienhua Wu. "Moderating effect of environmental supply chain collaboration." International Journal of Physical Distribution & Logistics Management 45, no. 9/10 (October 5, 2015): 959–78. http://dx.doi.org/10.1108/ijpdlm-08-2014-0183.
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Purpose – The purpose of this paper is to explore how corporate environmental strategies, namely, environmental management strategy (EMS) and green product strategy (GPS), affect the competitiveness of a firm. In addition, this study investigates whether the environmental collaboration in supply chains (ECSC), namely, environmental collaboration with suppliers (ECS), and environmental collaboration with customers (ECC) moderate the environment-performance relationship. Design/methodology/approach – Survey methodology and regression modeling are adopted to assess the relationship between corporate environmental strategy and competitive performance of a company, including the moderating effects of ECSC. Findings – Competitiveness is positively affected by EMS and GPS. ECSC moderately affects the links among EMS, GPS, and competitiveness. Regarding the differences between the impacts of ECS and ECC on performance, only ECS acts as a moderator in the enhancement of EMS and GPS. Thus, ECS positively contributes to enhance competitive advantage. In contrast to perceptions, ECC directly improves firm competitiveness. Research limitations/implications – The findings support the understanding that the moderating role of ECSC may explain the conflicting results in environment-performance linkages. In particular, suppliers and customers could impact EMS and GPS in direct or interactive ways, or both, to enhance the performance of a firm. Practical implications – Significant performance improvements are influenced not only by the real environmental commitment of companies to internal green management but also by the positive relations of firms with their external cooperative capabilities in environmental relationships with chain partners. Originality/value – This research is the first to suggest and empirically test the moderating impacts of ECSC on the relationship between corporate environmental strategy and competitiveness.
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Podsiadło, Paweł, Adam Nogalski, Sylweriusz Kosiński, Tomasz Sanak, Kinga Sałapa, Robert Gałązkowski, and Tomasz Darocha. "IS AN EMERGENCY DEPARTMENT A SAFER PLACE FOR HYPOTHERMIC VICTIMS THAN AN AMBULANCE? A COMPARISON OF THE KNOWLEDGE OF MEDICAL PERSONNEL CONCERNING HYPOTHERMIA." Wiadomości Lekarskie 72, no. 2 (2019): 209–15. http://dx.doi.org/10.36740/wlek201902113.
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Introduction: Improper initial management of a victim in severe hypothermia is associated with a risk of cardiac arrest. At the same time, an uncontrolled drop in core body temperature in trauma victims is an independent risk factor for mortality. Medical personnel require a thorough understanding of the pathophysiology and treatment of hypothermia. Gaps in this understanding can lead to serious complications for patients. The aim: To compare knowledge concerning hypothermia between medical personnel working in emergency departments (ED) and emergency medical services (EMS). Materials and methods: A total of 5,362 participants were included in the study. In this study, EMS and ED personnel were encouraged to participate in an e-learning course on hypothermia. Subsequently, the scores of a pre-test, lesson tests and post-test completed by participants of this course were compared. Results: Pre-test scores were significantly higher among personnel working in EMS compared with those working in EDs. Nurses employed in EDs had significantly more failures in completing the course than EMS nurses. The most difficult topics for all practitioners were post-traumatic hypothermia and hypothermia-related clotting disorders. Conclusions: EMS personnel have a higher level of knowledge of hypothermia than ED personnel. Moreover, an e-learning course is an effective tool for improving medical personnel’s knowledge of hypothermia.
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Yau, L., M. A. Mukarram, S. Kim, K. Arcot, K. Thavorn, M. Taljaard, M. Sivilotti, B. H. Rowe, and V. Thiruganasambandamoorthy. "LO083: Outcomes and resource utilization among syncope patients transported by emergency medical services." CJEM 18, S1 (May 2016): S58—S59. http://dx.doi.org/10.1017/cem.2016.120.
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Introduction: Syncope accounts for 1% of all annual emergency department (ED) visits in Canada with only 10.3% suffering serious adverse event (SAE) within 30-days. However, 66% are transported to ED by Emergency Medical Services (EMS). Our objectives were to assess 30 day SAE among syncope patients transported by Emergency medical services (EMS), assess the need to develop an EMS clinical decision aid, and estimate anticipated health care savings by diverting patients from the ED to alternative care pathways. Methods: We conducted a prospective cohort study at four tertiary care EDs from Feb 2012 to Feb 2013. We included patients ≥16 years of age with syncope and who arrived to the ED via EMS. We collected patient demographics, medical history, 30 day SAE, EMS time points (call received, EMS arrival on scene, EMS departure from scene, time of transfer of care in the ED), critical EMS interventions, and ED length of stay. We assessed for the occurrence of any SAE (death, arrhythmia, other cardiac and non-cardiac conditions) within 30 days of ED disposition. We used descriptive analysis, unpaired two-tailed t-test and chi-square test. Ethics approval was obtained at all study sites. Results: Of 1,475 ED patients with syncope during the study period, 992 (67.3%) arrived by EMS. Mean times (SD) for EMS arrival to the scene, patient assessment at the scene and transfer of patient from scene to the ED were 10.1 (6.4), 18.9 (8.3), and 14.6 (11.5) minutes respectively. Only two patients had critical interventions enroute (pacing and defibrillation). Overall 138 (13.9%) patients suffered a SAE; 32 (3.2%) detected by EMS, 58 (5.8%) detected during ED evaluation, 48 (4.8%) after ED disposition. The average ED length of stay was 5.9(4.2) hours. Based on average of cost from two sites, we estimated that total cost of transporting syncope patients from the scene to the ED to be $4 million in Canada. The total cost of ED care for syncope patients transported by EMS in Canada was calculated at $21.5 million. Conclusion: A substantial proportion of patients arriving to the ED via EMS suffer no SAE within 30 days. Correspondingly, our results suggest a need for an EMS clinical decision aid to divert low-risk syncope patients to alternative care pathways such as family physicians or rapid access clinics. If developed and implemented, this tool can potentially reduce EMS burden, ED crowding, and reduce healthcare costs.
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RAMADHAN, AGUNG, ARIES SUBIANTORO, JUAN THOMAS WIJAYA, and SYAFIIE SYAMAUN. "Optimasi Kinerja Fuel Cell pada Sistem Kereta Hibrida menggunakan Metode External Energy Maximization Strategy." ELKOMIKA: Jurnal Teknik Energi Elektrik, Teknik Telekomunikasi, & Teknik Elektronika 11, no. 2 (April 17, 2023): 537. http://dx.doi.org/10.26760/elkomika.v11i2.537.
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ABSTRAKDalam sistem sumber daya hibrida, strategi manajemen energi (EMS) pada dasarnya hanya mengatur pembagian daya tanpa mempertimbangkan optimalisasi kinerja sistem. Oleh karena itu pada penelitian ini dirancang EMS berbasis optimasi pada kereta hibrida dengan sumber daya fuel cell (FC), baterai dan superkapasitor dengan metode External Energy Maximization Strategy (EEMS). Strategi ini dirancang untuk memaksimalkan energi yang disuplai oleh baterai dan superkapasitor melalui state of charge (SOC) baterai dan tegangan DC bus sehingga dapat meminimalisasi konsumsi hidrogen dan meningkatkan efisiensi keseluruhan sistem. Hasil simulasi memperlihatkan bahwa strategi ini mampu memaksimalkan kinerja baterai dan superkapasitor. Efisiensi sistem berhasil ditingkatkan menjadi 86,37% dan konsumsi hidrogen berhasil dikurangi 10% dari strategi pembandingnya. State of charge (SOC) baterai juga mampu dipertahankan untuk tetap dalam rentang batas yang telah ditentukan.Kata kunci: EMS, kereta hibrida, fuel cell, baterai, superkapasitor, optimasi ABSTRACTThe energy management strategy (EMS) in a hybrid system essentially only regulates power sharing without considering system performance optimization. This study developed an EMS based on the optimization of hybrid train with fuel cell (FC), battery, and supercapacitor power sources using the External Energy Maximization Strategy (EEMS). This strategy is intended to maximize the energy supplied by battery and supercapacitor through the SOC of the battery and DC bus voltage, thereby reducing hydrogen consumption and increasing overall system efficiency. The simulation results show that this strategy can maximize battery and supercapacitor. The system efficiency was successfully increased to 86.37%, and the hydrogen consumption was reduced by 10% when compared to the comparison strategy. The SOC of the battery can also be kept within a certain range.Keywords: EMS, hybrid train, fuel cell, battery, supercapasitor, optimization
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Kim, Jiyoung, Choongrak Kim, and Song Yi Park. "Impact of COVID-19 on Emergency Medical Services for Patients with Acute Stroke Presentation in Busan, South Korea." Journal of Clinical Medicine 11, no. 1 (December 24, 2021): 94. http://dx.doi.org/10.3390/jcm11010094.
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The purpose of this retrospective observational study was to identify the impact of COVID-19 on emergency medical services (EMS) processing times and transfers to the emergency department (ED) among patients with acute stroke symptoms before and during the COVID-19 pandemic in Busan, South Korea. The total number of patients using EMS for acute stroke symptoms decreased by 8.2% from 1570 in the pre-COVID-19 period to 1441 during the COVID-19 period. The median (interquartile range) EMS processing time was 29.0 (23–37) min in the pre-COVID-19 period and 33.0 (25–41) minutes in the COVID-19 period (p < 0.001). There was a significant decrease in the number of patients transferred to an ED with a comprehensive stroke center (CSC) (6.37%, p < 0.001) and an increase in the number of patients transferred to two EDs nearby (2.77%, p = 0.018; 3.22%, p < 0.001). During the COVID-19 pandemic, EMS processing time increased. The number of patients transferred to ED with CSC was significantly reduced and dispersed. COVID-19 appears to have affected the stroke chain of survival by hindering entry into EDs with stroke centers, the gateway for acute stroke patients.
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Weaver, Matthew D., Charity G. Moore, P. Daniel Patterson, and Donald M. Yealy. "Medical Necessity in Emergency Medical Services Transports." American Journal of Medical Quality 27, no. 3 (December 27, 2011): 250–55. http://dx.doi.org/10.1177/1062860611424331.
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The purpose of this study was to generate national estimates of the prevalence of medically unnecessary emergency medical services (EMS) transports to emergency departments (EDs) over time and to identify characteristics that may be associated with medically unnecessary transports. A previously published algorithm was applied to operationalize medical necessity based on ED diagnosis to 10 years of data from the National Hospital Ambulatory Medical Care Survey. The trend over time was reported using descriptive statistics weighted to produce national estimates. Nationally, the proportion of EMS transports that were medically unnecessary increased from 13% to 17% over the 10-year study period. Individual demographic characteristics, including insurance status, were not predictive of inappropriate utilization. EMS transports for medically unnecessary complaints increased from 1997 to 2007. Our findings from a nationally representative sample highlight the opportunity for alternative patient delivery strategies for select patients seeking EMS services.
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García Alcaraz, Jorge Luis, José Roberto Díaz Reza, Karina Cecilia Arredondo Soto, Guadalupe Hernández Escobedo, Ari Happonen, Rita Puig I Vidal, and Emilio Jiménez Macías. "Effect of Green Supply Chain Management Practices on Environmental Performance: Case of Mexican Manufacturing Companies." Mathematics 10, no. 11 (May 30, 2022): 1877. http://dx.doi.org/10.3390/math10111877.
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Managers implement several Green Supply Chain Management (GSCM) practices to improve sustainability and economic performance, such as environmental management systems (EMS), eco-design (ED), source reduction (SR) and attending to external environmental management (EEM) requirements; however, the relationship among them requires a deep study. This paper reports the case of the Mexican maquiladora industry, analyzing the main relationships among GSCM practices with environmental impact (EI) and environmental cost savings (ECS). The analysis reports three structural equation models (SEM) developed as simple, second-order, and mediating models. Those relationships are tested using 160 responses to a survey applied to the Mexican maquiladora industry and with partial least squares algorithms (PLS), where conditional probabilities for different scenarios in latent variables are also reported. Findings indicate that EMS has a direct effect on EI (β = 0.442) and ECS (β = 0.227), indicating that EMS reduces EI and cost associated with the production process; however, ED has no direct effect on EI (β = 0.019) and ECS ((β = 0.006), and it can be due to the maquiladora nature as foreign companies focused on manufacturing and not to product design.
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Dickinson, Edward T., Vincent P. Verdile, Timothy B. Duncan, and Kerry A. Bryant. "56. Managed Care Organization Enrollee Utilization of 911 Emergency Medical Services." Prehospital and Disaster Medicine 11, S2 (September 1996): S34. http://dx.doi.org/10.1017/s1049023x00045738.
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Purpose: The accessibility of emergency medical services (EMS) for enrollees of managed care organizations (MCOs) is currently a topic of national debate. The mechanisms by which enrollees currently enter the EMS system have not been well described. The purpose of this study was to determine how these patients enter our EMS system.Methods: All enrollees who belong to the region's largest MCO and who were transported to hospital EDs by the paramedic level municipal EMS department were identified from billing records. Members of the MCO are mandated to call the MCO prior to seeking any emergency care. Dispatch logs were then examined to determine the time and origin of the call to the 911 communications center. Patient care records were used to obtain patient age, the level of care (ALS vs. BLS), and whether the ALS patient received medications (ALS Meds).Results: Over a six month period 195 enrollees were transported to EDs, Three modes of system entry were identified: Group I—enrollees who called 911 directly; Group II—enrollees who called the MCO triage center who then called 911 for the patient; and Group III—enrollees who were sent to the MCO center for evaluation and subsequently the MCO called 911 to transport the patient to the hospital.
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Spaepen, Kris, Robby Cardinas, Winne A. P. Haenen, Leonard Kaufman, and Ives Hubloue. "The Impact of In-Event Health Services at Europe’s Largest Electronic Dance Music Festival on Ems and Ed in the Host Community." International Journal of Environmental Research and Public Health 20, no. 4 (February 11, 2023): 3207. http://dx.doi.org/10.3390/ijerph20043207.
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Background: Electronic dance music festivals (EDMF) can cause a significant disruption in the standard operational capacity of emergency medical services (EMS) and hospitals. We determined whether or not the presence of in-event health services (IEHS) can reduce the impact of Europe’s largest EDMF on the host community EMS and local emergency departments (EDs). Methods: We conducted a pre-post analysis of the impact of Europe’s largest EDMF in July 2019, in Boom, Belgium, on the host community EMS and local EDs. Statistical analysis included descriptive statistics, independent t-tests, and χ2 analysis. Results: Of 400,000 attendees, 12,451 presented to IEHS. Most patients only required in-event first aid, but 120 patients had a potentially life-threatening condition. One hundred fifty-two patients needed to be transported by IEHS to nearby hospitals, resulting in a transport-to-hospital rate of 0.38/1000 attendees. Eighteen patients remained admitted to the hospital for >24 h; one died after arrival in the ED. IEHS limited the overall impact of the MGE on regular EMS and nearby hospitals. No predictive model proved optimal when proposing the optimal number and level of IEHS members. Conclusions: This study shows that IEHS at this event limited ambulance usage and mitigated the event’s impact on regular emergency medical and health services.
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Deufel, Felix, Martin Gießler, and Frank Gauterin. "Optimal Control of Electrified Powertrains in Offline and Online Application Concerning Dimensioning of Li-Ion Batteries." Vehicles 4, no. 2 (May 19, 2022): 464–81. http://dx.doi.org/10.3390/vehicles4020028.
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Various energy management systems (driving strategies) have been developed to improve the efficiency of electrified vehicle drives. These include strategies from the field of offline optimization to determine the theoretical optimum for a given system, as well as online strategies designed for an on-board application in the vehicle. In this paper, investigations are performed on an SUV electrified by a 48 V hybrid system in P14 topology regarding both offline and online strategies. To calculate the global optimum, the performance of Dynamic Programming (DP) compared to an Equivalent Consumption Minimization Strategy (ECMS) with an iteratively determined equivalence factor is shown. Furthermore, with regard to online energy management strategies (EMS), it is presented how a predictive Online ECMS achieves additional fuel savings compared to a robust, non-predictive implementation. The simulation-based vehicle development allows detailed investigations regarding interactions between battery requirements and EMS. In this context, it is shown how various battery capacities are exploited by the discussed EMS.
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Sun, Weiwei, Ji Shen, Shi-Yong Yu, Hao Long, Enlou Zhang, Enfeng Liu, and Rong Chen. "A lacustrine record of East Asian summer monsoon and atmospheric dust loading since the last interglaciation from Lake Xingkai, northeast China." Quaternary Research 89, no. 1 (October 23, 2017): 270–80. http://dx.doi.org/10.1017/qua.2017.81.
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AbstractA 336-cm-long sediment core spanning the last 130 ka was recovered from Lake Xingkai on the northeastern margin of the East Asian summer monsoon domain to reveal the linkage between lacustrine depositional processes and environmental changes. Bayesian end member modeling analysis was conducted to partition and interpret the grain-size distributions of Lake Xingkai sediments. Our results suggest that the sedimentary system is characterized by three end members (EMs). EM1 and EM2, with a modal value of 13 and 10 μm, respectively, indicate the variation of local hydraulic conditions. EM3, with a modal value of 5 μm, reflects the background atmospheric dust loading. High atmospheric dust concentration generally occurred during Marine Isotope Stage (MIS) 5d, MIS 4, and early MIS 3, when the climate in the Asian dust source region was cold and dry. In contrast, low dust concentration prevailed during MIS 2, likely due to the southward shift of the westerlies driven by maximum ice volume in the high latitudes.
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Hortobágyi, Tibor, Jean Lambert, and Kevin Scott. "Incomplete Muscle Activation After Training With Electromyostimulation." Canadian Journal of Applied Physiology 23, no. 3 (June 1, 1998): 261–70. http://dx.doi.org/10.1139/h98-014.
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Training with voluntary or electromyostimulation (EMS)-evoked eccentric contractions should produce complete muscle activation, since EMS and eccentric contractions preferentially recruit large motor units. Subjects (22 women ages 18-40) were randomly assigned to a voluntary (VOL; n = 8), EMS (n = 8), or control group. VOL and EMS groups trained the quadriceps at the same, increasing force levels 4 times/week for 6 weeks using voluntary or EMS-evoked eccentric contractions. VOL improved voluntary more than EMS-evoked eccentric strength. EMS improved EMS-evoked strength more than voluntary. EMS training improved EMS-evoked eccentric strength more than VOL training improved voluntary eccentric strength. EMS-evoked to voluntary force ratio increased from 0.57 (±0.11) to 1.20 (±0.35) in EMS and did not change in VOL (all changes p < .05). Six of eight EMS subjects produced greater EMS-evoked force posttraining, suggesting incomplete muscle activation after EMS training. Key words: exercise, eccentric contraction, muscle activation
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Pérez, Wilson, Punit Tulpule, Shawn Midlam-Mohler, and Giorgio Rizzoni. "Data-Driven Adaptive Equivalent Consumption Minimization Strategy for Hybrid Electric and Connected Vehicles." Applied Sciences 12, no. 5 (March 5, 2022): 2705. http://dx.doi.org/10.3390/app12052705.
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Advanced energy management strategies (EMS) are used to control the power flow through a vehicle’s powertrain. However, the cost of high-power computational hardware and lack of a priori knowledge of future road conditions poses difficult challenges for engineers attempting to implement globally optimal frameworks. One solution is to use advanced driver assistance systems (ADAS) and connectivity to obtain a prediction of future road conditions. This paper presents a look-ahead predictive EMS which combines approximate dynamic programming (ADP) methods and an adaptive equivalent consumption minimization strategy (A-ECMS) to obtain a near-optimal solution for a future prediction horizon. ECMS is highly sensitive to the equivalence factor (EF), making it necessary to adapt during a trip to account for disturbances. A novel adaptation method is presented in this work which uses an artificial neural network to learn the nonlinear relationship between a speed and the state of charge (SOC) trajectory prediction obtained from ADP to estimate the corresponding EF. A traffic uncertainty analysis demonstrates an approximately 10% fuel economy (FE) improvement over traditional A-ECMS. Using a data-driven adaptation method for A-ECMS informed by a dynamic programming (DP) based prediction results in an EMS capable of online implementation.
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Li, Hua, Walter Villanueva, Markku Puustinen, Jani Laine, and Pavel Kudinov. "Validation of Effective Models for Simulation of Thermal Stratification and Mixing Induced by Steam Injection into a Large Pool of Water." Science and Technology of Nuclear Installations 2014 (2014): 1–18. http://dx.doi.org/10.1155/2014/752597.
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The Effective Heat Source (EHS) and Effective Momentum Source (EMS) models have been proposed to predict the development of thermal stratification and mixing during a steam injection into a large pool of water. These effective models are implemented in GOTHIC software and validated against the POOLEX STB-20 and STB-21 tests and the PPOOLEX MIX-01 test. First, the EHS model is validated against STB-20 test which shows the development of thermal stratification. Different numerical schemes and grid resolutions have been tested. A48×114grid with second order scheme is sufficient to capture the vertical temperature distribution in the pool. Next, the EHS and EMS models are validated against STB-21 test. Effective momentum is estimated based on the water level oscillations in the blowdown pipe. An effective momentum selected within the experimental measurement uncertainty can reproduce the mixing details. Finally, the EHS-EMS models are validated against MIX-01 test which has improved space and time resolution of temperature measurements inside the blowdown pipe. Excellent agreement in averaged pool temperature and water level in the pool between the experiment and simulation has been achieved. The development of thermal stratification in the pool is also well captured in the simulation as well as the thermal behavior of the pool during the mixing phase.
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Yao, Dongwei, Xinwei Lu, Xiangyun Chao, Yongguang Zhang, Junhao Shen, Fanlong Zeng, Ziyan Zhang, and Feng Wu. "Adaptive Equivalent Fuel Consumption Minimization Based Energy Management Strategy for Extended-Range Electric Vehicle." Sustainability 15, no. 5 (March 4, 2023): 4607. http://dx.doi.org/10.3390/su15054607.
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Unlike battery electric vehicles, extended-range electric vehicles have one more energy source, so a reasonable energy management strategy (EMS) is crucial to the fuel economy of the vehicles. In this paper, an adaptive equivalent fuel consumption minimization strategy (A-ECMS)-based energy management strategy is proposed for the extended-range electric vehicle. The equivalent fuel consumption minimization strategy (ECMS), which utilizes Pontryagin’s minimum principle (PMP), is introduced to design the EMS. Compared with other ECMS strategies, an adaptive equivalent factor algorithm, based on state of charge (SOC) feedback and a proportional–integral (PI) controller is designed to update the equivalent factor under different working conditions. Additionally, a start–stop penalty is added to the objective function to take the dynamic start–stop process of the range extender into account. As a result, under the WLTC driving cycle, the proposed strategy can achieve 6.78 L/100 km comprehensive fuel consumption, saving 6.2% and 3.4% fuel consumption compared with the conventional rule-based thermostat strategy and the power following strategy. Moreover, the proposed EMS achieves the lowest ampere-hour flux among the three EMSs, indicating its ability to improve battery life.
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Chen, Xu, Guangdi Hu, Feng Guo, Mengqi Ye, and Jingyuan Huang. "Switched Energy Management Strategy for Fuel Cell Hybrid Vehicle Based on Switch Network." Energies 13, no. 1 (January 3, 2020): 247. http://dx.doi.org/10.3390/en13010247.
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Environmentally friendly and pollution-free fuel cell/lithium battery hybrid vehicles have received the attention of the community in recent years. It is imperative for fuel cell/lithium battery hybrid vehicles to use the energy management strategy (EMS) to distribute the output power of each power source to improve fuel economy and system life. In practical application, inconsistency of battery pack will lead to security hazard and capacity degradation. However, few EMS take the inconsistency of battery pack into account. Also, the current battery equalization strategy rarely discusses how to perform the equilibrium process while meeting the power demand of vehicle. To solve these issues, a novel equalization energy management strategy (EEMS) based on the switch network is proposed at first. Then, a switched energy management strategy (SEMS) that switches between the EEMS and the equivalent consumption minimization strategy (ECMS) is proposed and implemented in the fuel cell/lithium battery hybrid system to validate its effectiveness. The results show that the proposed SEMS can ameliorate the inconsistency of series lithium battery pack while meeting the power demand of vehicle’s normal operation. It can improve the safety and durability of the system and reduce the equalization time. Besides, it has good expansibility and no energy waste.
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Wang, Xinyue, Zhaofeng Zhang, Weiwei Zeng, Yuqing Zhong, Dandan Xie, Weiqiang Zhu, Fujia Chen, Jing Du, and Tingting Zhang. "Establishment of DNA Methylation Profile Associated with TCM Syndrome in Endometriosis." Evidence-Based Complementary and Alternative Medicine 2022 (April 11, 2022): 1–8. http://dx.doi.org/10.1155/2022/4866360.
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Objectives. To screen the potential epigenetic biomarkers associated with endometriosis (EMS) and traditional Chinese medicine (TCM) syndrome EMS types. Methods. A cohort of 99 participants comprising 42 EMS patients with cold coagulation blood stasis (CCBS) syndrome, 35 EMS patients with Qi stagnation blood stasis (QSBS) syndrome, and 22 women of childbearing age without EMS were recruited. Reduced representation bisulfite sequencing (RRBS) was used to establish the differential DNA methylation profiles in human peripheral blood samples obtained from four non-EMS and four EMS patients with CCBS or QSBS syndrome, respectively. Differentially expressed genes (DEGs) were verified in 18 non-EMS, 38 CCBS-EMS, and 31 QSBS-EMS using pyrosequencing. Results. Methylation sites of 123942, 127229, and 115961 were found in peripheral blood DNA of non-EMS, CCBS-EMS, and QSBS-EMS patients, respectively. GO and KEGG analyses showed that the pathological process of EMS may be closely related to the nervous system development, cell junctions, GABA-gated chloride ion channel activity, nicotine addiction, Hippo signaling pathway, mRNA surveillance pathway, and Wnt signaling pathway. The methylation level at CpG site within HDAC6 gene in QSBS-EMS patients was significantly different from that in control women. Conclusions. The changes in DNA methylation in peripheral blood samples may be associated with EMS and TCM syndrome EMS types. The methylation level of HDAC6 gene may be used to distinguish QSBS-EMS patients from women without EMS.
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Ha, Seongmin, and Hyeongcheol Lee. "Energy Management Strategy Based on V2X Communications and Road Information for a Connected PHEV and Its Evaluation Using an IDHIL Simulator." Applied Sciences 13, no. 16 (August 13, 2023): 9208. http://dx.doi.org/10.3390/app13169208.
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Conventional energy management strategies (EMSs) of hybrid electric vehicles (HEVs) only utilize in-vehicle information, such as an acceleration pedal, velocity, acceleration, engine RPM, state of charge (SOC), and radar. This paper presents a new EMS using out-vehicle information obtained by vehicle to everything (V2X) communication. The new EMS integrates cooperative eco-driving (CED) guidance and an adaptive equivalent consumption minimum strategy (A-ECMS) based on V2X communication information and road information. CED provides a guide signal and a guide speed to the driver. It guides pedal behavior in terms of coasting driving, acceleration and deceleration, and target speed. A-ECMSs calculate the target SOC based on the simplified road information of the planned route and reflects it in the equivalent factor. An integrated driving hardware-in-the-loop (IDHIL) simulator is also built to prove the new EMS by integrating a V2X communication device, a VANET simulator, and a vehicle simulator. The IDHIL test results demonstrate the validity and performance of the proposed EMS in a V2X communication environment.
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Yau, L., M. A. Mukarram, S. Kim, K. Arcot, K. Thavorn, M. Taljaard, M. Sivilotti, B. H. Rowe, and V. Thiruganasambandamoorthy. "LO31: Identification of high risk factors associated with 30 day serious adverse events among syncope patients transported to the emergency department by emergency medical services." CJEM 19, S1 (May 2017): S38. http://dx.doi.org/10.1017/cem.2017.93.
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Introduction: The majority of syncope patients transported to the emergency department (ED) by emergency medical services (EMS) are low-risk with very few suffering serious adverse events (SAE) within 30-days and over 50% are diagnosed with vasovagal syncope. These patients can potentially be diverted by EMS to alternate pathways of care (primary care or syncope clinic) if appropriately identified. We sought to identify high-risk factors associated with SAE within 30-days of ED disposition as a step towards developing an EMS clinical decision tool. Methods: We prospectively enrolled adult syncope patients who were transported to 5 academic EDs by EMS. We collected standardized variables at EMS presentation from history, clinical examination and investigations including ECG and ED disposition. We also collected concerning symptoms identified and EMS interventions. Adjudicated SAE included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, hemorrhage and procedural interventions. Multivariable logistic regression was used for analysis. Results: 990 adult syncope patients (mean age 58.9 years, 54.9% females and 16.8% hospitalized) were enrolled with 137 (14.6%) patients suffering SAE within 30-days of ED disposition. Of 42 candidate predictors, we identified 5 predictors that were significantly associated with SAE on multivariable analysis: ECG abnormalities [OR=1.77; 95%CI 1.36-2.48] (non-sinus rhythm, high degree atrioventricular block, left bundle branch block, ST-T wave changes or Q waves), cardiac history [OR=2.87; 95%CI 1.86-4.41] (valvular or coronary heart disease, cardiomyopathy, congestive heart failure, arrhythmias or device insertions), EMS interventions or concerning symptoms [OR=4.88; 95%CI 3.13- 7.62], age >50 years [OR=3.18; 95%CI 1.68-6.02], any abnormal vital signs [OR=1.58; 95%CI 1.03-2.42] (any EMS systolic blood pressure >180 or <100 mmHg, heart rate <50 or >100/minute, respiratory rate >25/minute, oxygen saturation <91%). [C-statistic: 0.81; Hosmer Lemeshow p=0.30]. Conclusion: We identified high-risk factors that are associated with 30-day SAE among syncope patients transported to the ED by EMS. This will aid in the development of a clinical decision tool to identify low-risk patients for diversion to alternate pathways of care.
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Wang, Hui, and Vikram M. Mehta. "Decadal Variability of the Indo-Pacific Warm Pool and Its Association with Atmospheric and Oceanic Variability in the NCEP–NCAR and SODA Reanalyses." Journal of Climate 21, no. 21 (November 1, 2008): 5545–65. http://dx.doi.org/10.1175/2008jcli2049.1.
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Abstract Decadal variability of the Indo-Pacific warm pool (IPWP) sea surface temperature (SST) and its association with atmospheric and oceanic circulations are investigated with observed 50-yr (1952–2001) SST, and the NCEP–NCAR atmospheric and Simple Ocean Data Assimilation (SODA) oceanic reanalysis data. The decadal variability of the IPWP SSTs was analyzed by applying an empirical orthogonal function technique to low-pass-filtered SSTs. Two leading empirical modes (EMs) well represent the IPWP SST decadal variations. EM1 is an ENSO-like pattern with out-of-phase SST anomalies in the western Pacific and the Indian Ocean, whereas EM2 displays an in-phase relationship between SST anomalies in the two regions. Consequently, spatial evolution of EM1 is dominated by opposing changes in zonal and meridional dimensions and thus a strong deformation of the warm pool on decadal time scales. EM2 is dominated by changes in size and intensity of the warm pool. Analyses of ocean thermodynamic fields associated with the two SST EMs indicate that decadal changes in the IPWP can extend down to 300-m depth. Oceanic processes may thus be involved in the IPWP decadal variability, including advections of mean temperature by both mean and anomalous ocean currents and effects of shallow tropical circulations (STCs) on the IPWP SST, which is consistent with some previous studies on tropical decadal variability. The results may also indicate the existence of both positive and negative feedbacks between the IPWP SST and the STCs. Both December–January–February (DJF) and June–July–August (JJA) atmospheric circulations exhibit thermally direct responses to the two decadal IPWP SST EMs by altering the Hadley and Walker circulations. In addition, significant upper-level rotational flow anomalies in the extratropics are found to be associated with the decadal IPWP SST variability. Consistent with the upper-level flow anomalies and 850-hPa convergence–divergence patterns associated with the two SST EMs are rainfall anomalies over the United States. In DJF, the rainfall anomalies are mainly in Florida, the Gulf Coast, southern Texas, Arizona, and along the West Coast. In JJA, the rainfall anomalies are mainly in the Midwest and the Southeast. Since these rainfall anomalies are a significant fraction of seasonal-average rainfall and since these anomalies persist for many years, they potentially make a significant impact on U.S. water resources and agriculture. Further analysis of observations and modeling studies are required to understand the physics of the IPWP SST decadal variability and its impacts on global climate, and to assess its predictability.
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Sallur, N. M., L. Z. Weier, L. I. Pahl, S. B. Holmes, and C. S. Yeoman. "EMS in the pastoral industries of western Queensland: from customisation to implementation." Australian Journal of Experimental Agriculture 47, no. 3 (2007): 284. http://dx.doi.org/10.1071/ea06020.
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This paper outlines the customisation of Environmental Management Systems (EMS) for the pastoral industry of western Queensland, the recruitment and training of pastoral producers, and their development and implementation of EMS. EMS was simplified to a 7-step process and producers were recruited to trial this customised EMS. Producers from 40 properties received EMS training, either as groups or individually. Of these, 37 commenced Pastoral EMS development through a facilitated approach that allowed them to learn about EMS while developing an EMS for their property. EMS implementation has been more effective with producers who were trained in groups. At this stage, however, most producers do not see value in EMS as there are currently no strong drivers to warrant continued development and implementation. Key findings resulting from this work were that personal contact and assistance is vital to encourage producers to trial EMS, and that a staged approach to EMS implementation, commencing with a self-assessment, is recommended. EMS training is most successful in a group situation; however, an alternative method of delivery should be provided for those producers who, either by choice or isolation, have to work alone. A support network is also necessary to encourage and maintain progress with EMS development and implementation, particularly where no strong drivers exist.
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Venesoja, Anu, Maaret Castrén, Susanna Tella, and Veronica Lindström. "Patients’ perceptions of safety in emergency medical services: an interview study." BMJ Open 10, no. 10 (October 2020): e037488. http://dx.doi.org/10.1136/bmjopen-2020-037488.
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BackgroundResearch on patient safety in emergency medical services (EMS) has mainly focused on the organisation’s and/or the EMS personnel’s perspective. Little is known about how patients perceive safety in EMS. This study aims to describe the patients’ experiences of their sense of safety in EMS.MethodsA qualitative design with individual interviews of EMS patients (n=21) and an inductive qualitative content analysis were used.ResultsPatients’ experiences of EMS personnel’s ability or inability to show or use their medical, technical and driving skills affected the patients’ sense of safety. When they perceived a lack of professionalism and knowledge among EMS personnel, they felt unsafe. Patients highlighted equality in the encounter, the quality of the information given by EMS personnel and the opportunity to participate in their care as important factors creating a sense of safety during the EMS encounter. Altogether, patients’ perceptions of safety in EMS were connected to their confidence in the EMS personnel.ConclusionsOverall, patients felt safe during their EMS encounter, but the EMS personnel’s professional competence alone is not enough for them to feel safe. Lack of communication or professionalism may compromise their sense of safety. Further work is needed to explore how patients’ perceptions of safety can be used in improving safety in EMS.
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Al-Otaibi, Ahmed M., Sultan M. Alghadeer, Yazed Sulaiman AlRuthia, Abdulmajeed Mobrad, Mohammed A. Alhallaf, Abdullah A. Alghamdi, Saqer M. Althunayyan, and Nawaf A. Albaqami. "The characteristics and distribution of emergency medical services in Saudi Arabia." Annals of Saudi Medicine 43, no. 2 (March 2023): 63–69. http://dx.doi.org/10.5144/0256-4947.2023.63.
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BACKGROUND: Emergency medical services (EMS) play an essential role in treating and transporting patients to hospitals or between hospitals. EMS providers must be distributed wisely across all regions of the country to meet healthcare needs during normal times and disasters. No previous study has investigated the characteristics and distribution of the EMS workforce in Saudi Arabia. OBJECTIVES: Examine the characteristics and distribution of the EMS workforce in Saudi Arabia to identify gaps and areas in need of improvement. Also, explore the sociodemographic and educational characteristics of licensed EMS providers in Saudi Arabia. DESIGN: Cross-sectional SETTINGS: EMS in Saudi Arabia METHODS: We included all licensed EMS providers in Saudi Arabia as of 23 December 2020 who were registered in the Saudi Commission for Health Specialties (SCFHS) database. Sociodemographics, where they earned certification, and their job affiliations were collected and categorized. MAIN OUTCOME MEASURES: EMS workforce distribution, gender, and EMS provider-to-population ratio. SAMPLE SIZE: 18 336 EMS providers; 8812 (48.1%) with documented job affiliations. RESULTS: The EMS provider-to-population ratio is very low. In Saudi Arabia, in general, the ratio is 1:3871 (based on n=8812 providers), which is low compared to the 1:1400 ratio for Australian EMS provider-to-population, for example. That makes it a challenge for EMS providers to meet the population’s needs, especially in times of disaster. The low ratio may have contributed to the delayed response time in Saudi Arabia (13 minutes for critical cases) which does not meet the international standard response time (8 minutes maximum). Also, only 3.5% of the total EMS providers registered were females, and the clear majority of all EMS providers were technicians. CONCLUSIONS: The growth in the EMS workforce, including the recruitment of more females into the workforce and more EMS specialists compared to EMS technicians and health assistants, is critical to reaching a satisfactory EMS provider-to-population ratio. LIMITATIONS: Most noteworthy of the limitations of this research are the insufficient statistics describing EMS distribution in Saudi Arabia, the lack of previous studies on the research topic in Saudi Arabia, and job affiliation not accurately recorded in the SCFHS database. CONFLICT OF INTEREST: None.
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Leszczyński, Piotr Konrad, Paulina Sobolewska, Bożena Muraczyńska, Paulina Gryz, and Adam Kwapisz. "Impact of COVID-19 Pandemic on Quality of Health Services Provided by Emergency Medical Services and Emergency Departments in the Opinion of Patients: Pilot Study." International Journal of Environmental Research and Public Health 19, no. 3 (January 22, 2022): 1232. http://dx.doi.org/10.3390/ijerph19031232.
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Background: The aim of this study was to assess the quality of assistance provided by emergency medical service (EMS) and hospital emergency department (ED) staff in the opinion of patients. Methods: Simple random sampling was performed to select the responders. A group of 131 people who correctly completed the questionnaire form was included in the study. The questionnaire was directed only to patients receiving EMS and/or ED assistance during the time period when the pandemic was announced in Poland. Results: Problems in the ED were reported by 38 people (31.15%), and calling EMS was reported as generating problems by 7 people (16.67%). Dissatisfaction with the help provided in EDs was reported by 33 patients (27.05%), and dissatisfaction with the help by EMS was reported by eight people (19.05%). The assessment of the patient’s satisfaction level significantly correlated with the waiting time in the ED (Spearman = 0.217; p = 0.016) as well as with the waiting for EMSs (Spearman = 0.403; p = 0.008). Conclusions: Patients of the ambulance service and hospital emergency departments during the pandemic positively assessed the actions of medical services, despite significant delays in providing health services.
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Drissi, E., S. Boulbaroud, H. Hami, A. O. T. Ahami, and F. Z. Azzaoui. "Early Maladaptives Schemas among call center staff in the Rabat Sale Kenitra region, Morocco." European Psychiatry 65, S1 (June 2022): S704—S705. http://dx.doi.org/10.1192/j.eurpsy.2022.1814.
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Introduction It is important to know the prevalence of the Early Maladaptives Schemas (EMS) in such population. Objectives The study of Early Maladaptives Schemas among call center staff in the Rabat Sale Kenitra region and possible socio-economics factors that may influence them. Methods The study involved 121 call center’s employees in the Rabat Sale Kenitra region. They responded to an informative questionnaire and to the SPI 26, with 26 items, including 13 early maladaptives schemas. Results 121 subjects were interviewed, 48.78% (n=59) men and 51.24% (n=62) women, a minimum age of 22 years, a maximum age of 60 years and an average of 31.74 7.93. Through the examination of the EMS’s results in adulthood, we note a decreasing ranking of active shemas according to the rate of participants: the EMS Unrelenting standards is active in 80.02% of our sample, the EMS Mistrust in 61,2%, the EMS Insufficient self-control in 47.9%, the EMS Abandonment in 47.1%, the EMS Insufficient self-control in 41.3%, the EMS Emotional inhibition in 38.8%, the EMS Vulnerability to harm or illness in 33.1%, the EMS Dependence in 31.4%, the EMS Selfsacrifice in 27,3%, the EMS Social Isolation in 19%, the EMS Emotional deprivation in 10.7%, the EMS failure in 8.3% and the EMS Enmeshment in 7,4%. Conclusions By comparing the rates of EMS in childhood and adulthood, it emerges that only the EMS Abandonment, Dependence and Insufficient self-control showed a disinensification, increasing successively from adulthood to childhood as follow :from 69.4% to 47.1% , from 52,9% to 31.4% and from 59.5% to 47.9%. Disclosure No significant relationships.
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Brooks, Ingrid A., Michael R. Sayre, Caroline Spencer, and Frank L. Archer. "An Historical Examination of the Development of Emergency Medical Services Education in the US through Key Reports (1966-2014)." Prehospital and Disaster Medicine 31, no. 1 (December 11, 2015): 90–97. http://dx.doi.org/10.1017/s1049023x15005506.
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AbstractIntroductionThe Emergency Medical Services (EMS) approach to emergency prehospital care in the United States (US) has global influence. As the 50-year anniversary of modern US EMS approaches, there is value in examining US EMS education development over this period. This report describes US EMS education milestones and identifies themes that provide context to readers outside the US.MethodAs US EMS education is described mainly in publications of federal US EMS agencies and associations, a Google search and hand searching of documents identified publications in the public domain. MEDLINE and CINAHL Plus were searched for peer reviewed publications. Documents were reviewed using both a chronological and thematic approach.ResultsSeventy-eight documents and 685 articles were screened, the full texts of 175 were reviewed, and 41 were selected for full review. Four historical periods in US EMS education became apparent: EMS education development (1966-1980); EMS education consolidation and review (1981-1989); EMS education reflection and change (1990-1999); and EMS education for the future (2000-2014). Four major themes emerged: legislative authority, physician direction, quality, and development of the profession.ConclusionDocuments produced through broad interprofessional consultations, with support from federal and US EMS authorities, reflect the catalysts for US EMS education development. The current model of US EMS education provides a structure to enhance educational quality into the future. Implementation evaluation of this model would be a valuable addition to the US EMS literature. The themes emerging from this review assist the understanding of the characteristics of US EMS education.BrooksIA, SayreMR, SpencerC, ArcherFL. An historical examination of the development of Emergency Medical Services education in the US through key reports (1966-2014). Prehosp Disaster Med. 2016;31(1):90–97.
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Hassler, Don. "EMS Soundbeam." Computer Music Journal 14, no. 4 (1990): 11. http://dx.doi.org/10.2307/3680787.
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&NA;. "EMS CONFERENCES." Critical Care Nursing Quarterly 14, no. 4 (February 1992): 78. http://dx.doi.org/10.1097/00002727-199202000-00012.
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&NA;. "EMS CONFERENCE." Critical Care Nursing Quarterly 15, no. 4 (February 1993): 89. http://dx.doi.org/10.1097/00002727-199302000-00011.
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&NA;. "EMS CONFERENCE." Critical Care Nursing Quarterly 16, no. 1 (May 1993): 87. http://dx.doi.org/10.1097/00002727-199305000-00011.
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Ward, L. D., and P. R. Gardner. "Electronic EMS." Batiment International, Building Research and Practice 14, no. 3 (May 1986): 180–83. http://dx.doi.org/10.1080/01823328608726741.
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Cone, David C., and Steven J. Davidson. "EMS Research." Annals of Emergency Medicine 32, no. 2 (August 1998): 273. http://dx.doi.org/10.1016/s0196-0644(98)70156-8.
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Fowler, Raymond L. "EMS Agenda." Prehospital and Disaster Medicine 7, no. 4 (December 1992): 318–19. http://dx.doi.org/10.1017/s1049023x00039728.
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Hergenroeder, Paul. "EMS fellowships." Annals of Emergency Medicine 18, no. 6 (June 1989): 710. http://dx.doi.org/10.1016/s0196-0644(89)80541-4.
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Spoor, John E. "Rural EMS." Annals of Emergency Medicine 21, no. 3 (March 1992): 343. http://dx.doi.org/10.1016/s0196-0644(05)80916-3.
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"Environmental Management System, Environmental Management Accounting, and Firm Performance in China’s Manufacturing Companies." Asian Journal of Accounting and Finance, November 1, 2022. http://dx.doi.org/10.55057/ajafin.2022.4.3.7.
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The aim of this study is to propose the relationship between environmental management system (EMS), environmental management accounting (EMA) and firm performance (FP) based on the Chinese manufacturing industry. Although the previous literature has already explored the effect of EMS adoption on FP, findings are inconclusive. Since there is also evidence that both EMS and EMA could potentially influence FP, it is worth considering the role of EMA as an intervening variable in this relationship. The survey of the study involved 131 manufacturing companies conducted in China. The data are analyzed using Smart Partial Least Square (SmartPLS) version 3 to evaluate the hypotheses of the study. The results showed that EMA mediates the relationship between EMS and firm performance. Therefore, this study contributes to the growing body of knowledge on EMS, EMA and firm performance, especially in the relatively new topic in China.
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Tan, Chantal D., Clementien L. Vermont, Joany M. Zachariasse, Ulrich von Both, Irini Eleftheriou, Marieke Emonts, Michiel van der Flier, et al. "Emergency medical services utilisation among febrile children attending emergency departments across Europe: an observational multicentre study." European Journal of Pediatrics, June 24, 2023. http://dx.doi.org/10.1007/s00431-023-05056-3.
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Abstract Children constitute 6–10% of all patients attending the emergency department (ED) by emergency medical services (EMS). However, discordant EMS use in children occurs in 37–61% with fever as an important risk factor. We aimed to describe EMS utilisation among febrile children attending European EDs. This study is part of an observational multicentre study assessing management and outcome in febrile children up to 18 years (MOFICHE) attending twelve EDs in eight European countries. Discordant EMS use was defined as the absence of markers of urgency including intermediate/high triage urgency, advanced diagnostics, treatment, and admission in children transferred by EMS. Multivariable logistic regression analyses were performed for the association between (1) EMS use and markers of urgency, and (2) patient characteristics and discordant EMS use after adjusting all analyses for the covariates age, gender, visiting hours, presenting symptoms, and ED setting. A total of 5464 (15%, range 0.1–42%) children attended the ED by EMS. Markers of urgency were more frequently present in the EMS group compared with the non-EMS group. Discordant EMS use occurred in 1601 children (29%, range 1–59%). Age and gender were not associated with discordant EMS use, whereas neurological symptoms were associated with less discordant EMS use (aOR 0.2, 95%CI 0.1–0.2), and attendance out of office hours was associated with more discordant EMS use (aOR 1.6, 95%CI 1.4–1.9). Settings with higher percentage of self-referrals to the ED had more discordant EMS use (p < 0.05). Conclusion: There is large practice variation in EMS use in febrile children attending European EDs. Markers of urgency were more frequently present in children in the EMS group. However, discordant EMS use occurred in 29%. Further research is needed on non-medical factors influencing discordant EMS use in febrile children across Europe, so that pre-emptive strategies can be implemented. What is Known: •Children constitute around 6–10% of all patients attending the emergency department by emergency medical services. •Discordant EMS use occurs in 37–61% of all children, with fever as most common presenting symptom for discordant EMS use in children. What is New: •There is large practice variation in EMS use among febrile children across Europe with discordance EMS use occurring in 29% (range 1–59%), which was associated with attendance during out of office hours and with settings with higher percentage of self-referrals to the ED. •Future research is needed focusing on non-medical factors (socioeconomic status, parental preferences and past experience, healthcare systems, referral pathways, out of hours services provision) that influence discordant EMS use in febrile children across Europe.
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Cai, Ping, Gregory Vogelaar, Kim Liss, and Hude Quan. "Determining Potentially Avoidable Emergency Medical Services (EMS) Transports: A Population Level Study Using Linked Administrative Data in Alberta Health Services (AHS)." International Journal of Population Data Science 3, no. 4 (August 23, 2018). http://dx.doi.org/10.23889/ijpds.v3i4.654.
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IntroductionTraditionally Emergency Medical Services (EMS) transports patients to Emergency Departments (EDs). However, some patients might be appropriately managed in alternative settings outside the ED. A number of non-traditional EMS programs have evolved in Alberta, in an attempt to provide quality care through a community-based care model.
Objectives and ApproachThe project aimed to identify and quantify potentially avoidable EMS transports to EDs in Alberta.
We identified 911 responses by ground ambulance in Alberta between September 1, 2017 and December 31, 2017. Patients 18 years and over transported to EDs were linked to Alberta Provincial Registry for more accurate demographic Information, and linked to Long Term Care (LTC) and ED data to capture patient characteristics and frequency of potentially avoidable EMS transports to EDs, defined as the Canadian Triage and Acuity Scale (CTAS) Level IV and Level V in EDs not requiring inpatient admission.
ResultsWe identified 72,182 transports to EDs, of which 1 in 4 patients were rural residents. After excluding individuals<18 years and non-Alberta residents, we were able to match 58,137 of the 60,020 EMS transports to EDs (96.8%). Overall, 7,697 (13%) were triaged as less urgent with no hospital admission. Patients 65 years and over accounted for almost half (49%) of the transports in this cohort, 6% of which were for LTC clients. Percentage of potentially avoidable transports in LTC clients were similar to seniors living in the community (12%). Geographic visualization at the provincial level indicated variation across the province. In general, rural residents were more likely than urban residents to be transported to EDs with less urgent conditions (18% vs 12%).
Conclusion/ImplicationsThis is the first analysis exploring potentially avoidable EMS transports to EDs in Alberta, Canada, where a comprehensive, single source of EMS system data is currently available. The project suggests opportunities for future EMS research and policies focusing on enhancing community–based care.
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Taboada Barber, Ana, Susan Lutz Klauda, Weimeng Wang, Kelly B. Cartwright, and Laurie E. Cutting. "Emergent Bilinguals With Specific Reading Comprehension Deficits: A Comparative and Longitudinal Analysis." Journal of Learning Disabilities, December 31, 2020, 002221942098324. http://dx.doi.org/10.1177/0022219420983247.
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This study centered on emergent bilingual (EB) students with specific reading comprehension deficits (S-RCD), that is, with poor reading comprehension despite solid word identification skills. The participants were 209 students in Grades 2 to 4, including both EBs and English Monolinguals (EMs) with and without S-RCD. Mean comparisons indicated that EBs and EMs with S-RCD showed weaknesses relative to typically developing (TD) readers in oral language, word identification, inference making, and reading engagement, but not in executive functioning. Longitudinal analyses indicated that across two academic years S-RCD persisted for 41% of EBs and EMs alike. Altogether, the study extends research on EBs with S-RCD by identifying variables beyond oral language that may account for their reading comprehension difficulties and providing insight into the extent to which their reading comprehension and word identification performance levels evolve during elementary school. Furthermore, the findings point to the importance of early identification and intervention for weaknesses in reading comprehension and its component elements in both EBs and EMS.
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Harjola, Pia, Tuukka Tarvasmäki, Cinzia Barletta, Richard Body, Jean Capsec, Michael Christ, Luis Garcia-Castrillo, et al. "The emergency department arrival mode and its relations to ED management and 30-day mortality in acute heart failure: an ancillary analysis from the EURODEM study." BMC Emergency Medicine 22, no. 1 (February 14, 2022). http://dx.doi.org/10.1186/s12873-022-00574-z.
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Abstract Background Acute heart failure patients are often encountered in emergency departments (ED) from 11% to 57% using emergency medical services (EMS). Our aim was to evaluate the association of EMS use with acute heart failure patients’ ED management and short-term outcomes. Methods This was a sub-analysis of a European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from European EDs. Patients with ED diagnosis of acute heart failure were categorized into two groups: those using EMS and those self-presenting (non- EMS). The independent association between EMS use and 30-day mortality was evaluated with logistic regression. Results Of the 500 acute heart failure patients, with information about the arrival mode to the ED, 309 (61.8%) arrived by EMS. These patients were older (median age 80 vs. 75 years, p < 0.001), more often female (56.4% vs. 42.1%, p = 0.002) and had more dementia (18.7% vs. 7.2%, p < 0.001). On admission, EMS patients had more often confusion (14.2% vs. 2.1%, p < 0.001) and higher respiratory rate (24/min vs. 21/min, p = 0.014; respiratory rate > 30/min in 17.1% patients vs. 7.5%, p = 0.005). The only difference in ED management appeared in the use of ventilatory support: 78.3% of EMS patients vs. 67.5% of non- EMS patients received supplementary oxygen (p = 0.007), and non-invasive ventilation was administered to 12.5% of EMS patients vs. 4.2% non- EMS patients (p = 0.002). EMS patients were more often hospitalized (82.4% vs. 65.9%, p < 0.001), had higher in-hospital mortality (8.7% vs. 3.1%, p = 0.014) and 30-day mortality (14.3% vs. 4.9%, p < 0.001). The use of EMS was an independent predictor of 30-day mortality (OR = 2.54, 95% CI 1.11–5.81, p = 0.027). Conclusion Most acute heart failure patients arrive at ED by EMS. These patients suffer from more severe respiratory distress and receive more often ventilatory support. EMS use is an independent predictor of 30-day mortality.
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Inkizhinov, Boris, Elena Gorenskaia, Dashi Nazarov, and Anton Klarin. "Entrepreneurship in emerging markets: mapping the scholarship and suggesting future research directions." International Journal of Emerging Markets ahead-of-print, ahead-of-print (January 6, 2021). http://dx.doi.org/10.1108/ijoem-11-2019-0988.
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PurposeTo provide a comprehensive systematic review of entrepreneurship in the context of emerging markets (EMs). The area of research is topical considering the rise of EMs on the global scene and the importance of entrepreneurship in the development of EMs.Design/methodology/approachThe paper utilizes scientometrics to provide a systematic review of the emerging field of entrepreneurship in EMs (EEMs). The entire Web of Science database was searched, and 2,568 scholarly outputs were extracted and analyzed as a result. The review further compares the EEMs research to the mainstream entrepreneurship research based on the top trending and high impact themes, demonstrates which countries published and are studied in the EEMs scholarship, and finally, it provides a proportion of empirical research done on EEMs to highlight methods utilized in the existing research.FindingsThe scientometric review reveals three broad domains of the EEMs scholarship–(1) Entrepreneurship in EMs and its implications; (2) MNEs, institutional environments, and FDI; and (3) Strategy, innovation and performance. The findings demonstrate that EEMs' scholarship primarily discusses environments within which EEMs takes place, the implications of EEMs, strategy and performance of EEMs (macro and meso-levels), thus highlighting the need for micro-level (individual-based) analysis of EEMs. Approximately, a third of the EEMs research is of empirical nature, more should be done especially in quantitative studies to develop this field further.Originality/valueThis research is unique in providing the largest review of EEMs scholarship. It divides the entire scholarship into three inter-related research streams and identifies future research directions in this immensely important field of research.
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Zou, Pengfei, Fazhan Tao, Zhumu Fu, Pengju Si, and Chao Ma. "Optimal energy management strategy for fuel cell/battery/supercapacitor vehicles using wavelet transform and equivalent consumption minimization strategy." Proceedings of the Institution of Mechanical Engineers, Part D: Journal of Automobile Engineering, December 30, 2021, 095440702110697. http://dx.doi.org/10.1177/09544070211069702.
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In this paper, the hybrid electric vehicle is equipped with fuel cell/battery/supercapacitor as the research object, the optimal energy management strategy (EMS) is proposed by combining wavelet transform (WT) method and equivalent consumption minimization strategy (ECMS) for reducing hydrogen consumption and prolonging the lifespan of power sources. Firstly, the WT method is employed to separate power demand of vehicles into high-frequency part supplied by supercapacitor and low-frequency part allocated to fuel cell and battery, which can effectively reduce the fluctuation of fuel cell and battery to prolong their lifespan. Then, considering the low-frequency power, the optimal SOC of battery is used to design the equivalent factor of the ECMS method to improve the fuel economy. The proposed hierarchical EMS can realize a trade-off between the lifespan of power sources and fuel economy of vehicles. Finally, the effectiveness of the proposed EMS is verified by ADVISOR, and comparison results are given compared with the traditional ECMS method and ECMS combining the filter.